Written by

Dan D’Ambrosio Free Press Staff Writer

In 1995, Burlington coffee consultant Dan Cox headed for Mexico on a coffee buying trip. Dr. Francis Fote, an obstetrician in Buffalo, N.Y., who had delivered Cox and many other members of his family, asked if he could tag along. Cox had become like his adopted son.

“He was bored in retirement,” Cox said in an interview last week. “I said ‘Fine you can come, but I can’t baby-sit you.’”

In a small town in southern Mexico called Pochutla, Fote wandered into the local hospital and introduced himself, striking up a conversation with the doctors on staff.

“What he learns is this hospital in this little town looks great from the outside, but when he goes inside the place is so understaffed and underperforming he can’t believe it,” Cox said. “There’s no full-time gynecologist on staff, and they’re not doing any preventative treatment for cervical cancer, which is the number one cause of death for women in Mexico.”

After his visit to the hospital in Pochutla, Fote buttonholed Cox and told him about what he had learned.

“He says, ‘Hey partner, this is crazy. We got to do something,’” Cox said.

Crazy because cervical cancer is one of the most preventable and treatable of the forms of cancer. In the United States, there were 4,210 deaths from cervical cancer in 2010, according to the American Cancer Society, Inc. Compare that with the 39,840 deaths from breast cancer, or 71,080 deaths from lung cancer, among women in 2010, according to the cancer society.

At first, Cox was at a loss. What did Fote expect him to do? But then things fell together, thanks to a man Cox remembers only as Paco, a member of a local coffee cooperative called Aztec Harvest.

“When you join a co-op, your number one member benefit is you should be able to sell product to clients you might not otherwise be able to get,” Cox said. “But they’re always looking to recruit co-op members so they’re always looking for more benefits.”

Such as health care. Paco told Cox and Fote that if they would do the screening for cervical cancer, he would arrange for the publicity and transportation.

“I asked him how he was going to arrange for transportation,” Cox said. “He said, ‘Simple, we’re going to use the coffee trucks.’”

For two years beginning in 1996, Cox and Fote funded and ran the cervical cancer screening clinic themselves. Then Cox went to Ben & Jerry’s, which gave him a $5,000 grant. Cox knew the company well because he sold them coffee extract for their ice cream. Next, Fletcher Allen Health Care offered volunteers to assist with the Pap smears. Green Mountain Coffee Roasters came on board as a funder, joining Ben & Jerry’s and Coffee Enterprises, Cox’s business.

But by 2000, Cox hit the wall. He had a business to run, and the clinic was cutting into that more than he could afford. Cox talked to his partners at Green Mountain and Ben & Jerry’s.

“I said, ‘Listen guys, I can’t do this any more and I can’t have my staff do it any more; it’s taking away from the revenue portion of my operation,’” Cox recalled. “We decided to form a board, become a nonprofit and hire an executive director.”

That nonprofit is Waterbury-based Grounds for Health, where the executive director is August Burns, a physician’s assistant and midwife, who has been working in women’s health care since 1977, and working internationally since 1986. Burns spotted a classified ad for the position in 2004 after the first executive director left.

“I was at a cafe with a friend. I said, ‘Oh there’s my job,’ literally, and put the ad in my pocket,” Burns said. “I had the job the next week.”

Fifteen years after Cox and Fote launched their clinic in Pochutla, Grounds for Health has directly screened 20,000 women for cervical cancer and has trained more than 250 nurses and doctors in the techniques required. The nonprofit is now working with nine coffee co-ops in Mexico, Nicaragua and Tanzania, the African nation having the dubious distinction of the highest rate of cervical cancer in the world, Burns said.

Grounds for Health is working with Jane Goodall and the Jane Goodall Institute in western Tanzania, where coffee farmers were clear-cutting the forests that provided habitat for the chimpanzees Goodall has worked with and protected for 45 years. Grounds for Health development director Jane Sakovitz Dale said coffee cooperatives in many more countries, including Peru, Colombia, El Salvador, Rwanda and Ethiopia, have reached out to the nonprofit, asking it to bring its program to their members.

“We just don’t have the resources at this point to meet the demand,” Dale said. “It’s a function of funding. If we had the funding it would allow us to have a much broader geographical impact. We’re at a tipping point of really being able to have an impact on this major global killer.”

The techniques Grounds for Health uses to deal with precancer in the women it screens changed dramatically seven years ago, Burns said, when the organization went away from the traditional model of taking a Pap smear and analyzing it before taking any action.

“We have women who come eight hours on foot to get a screening,” she said. “We can’t ask them to come back in a couple of weeks to check the results, then send them someplace else for treatment. You just lose all of them. You terrify them also. We’ve been pioneering this new approach, and it works really well.”

The new technique is called a single visit approach, and is what it sounds like. Women are examined and treated in a single visit. Even better, the procedure is low-tech, and low-cost, just 23 cents per visit, according to numbers verified by the Boston University School of Public Health. Burns is well aware that Grounds for Health’s low-tech approach would not be accepted in the developed world, where high-tech is king, but she is satisfied that it is highly effective, and that it has the potential to end cervical cancer’s reign as the leading killer of women in the world.

She tells the story of a group of 120 men she addressed in Tanzania, all coffee farmers, telling them about the risk to their loved ones and the importance of those women being screened “because often times it is the men who decide if she can go or not.”

“Not the next day, but the following day, a woman and her husband, the brother of a man at the meeting who told him he should take his wife, walked all day to our site, and stayed overnight,” Burns said. “She was seen first thing in the morning. She was positive, received treatment and they turned around and walked down the road away from us, and it was like, ‘This is worth doing.’”